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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) G .Date Issued / y.- .. Application is hereby made to the San'Joaquin Local Health District for a permit to construct and"install the work herein described. This application is made.10-compliance,with County Ordinance No. 549. '//s JOB ADDRESS AND OCA N . -- ---•_--- -------------�e -af t ---- - ""`-CIO, --.-- Owner's Name------------------ 7--iE-• ------ --- Phone ---',w ----------•-•-- Address-----1------------------------ r -- _... F' ( t�'{ ----•- Contractor's Name--------------------------------' ---------` # hone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 4 Number of living units: ___l__ Number of bedrooms I._ Number of baths __f--_ Lot size ___ 4____-/r_ -_- __�__--__ ----------- { Water Supply: Public system ❑ Commuriity'system .❑ Private �pfh to Water Table 1'6 ff.�- r r Character of soil to a depth of,3 feet:' Sand ❑ Gravel [] Sandy Loam Clay Loam ❑ Clay ❑ Adobe [] Hardpan [] Previous Application Made: Yes E] No New Construction: Yes p No L] FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS:"i F r ""'• y..�,I. wi (No.septic tank or`cesspaal permitµted if pubii/sewer is available within 204��}-1_-- Material � Septic Tank: Distancea'from ea est wel��. _ :D�stan� 'from k 3 y"t�L'Oin uid d7e t�h�_�__�______-___Ca acit �f� No. of compartments_________________ _ Size_ r� q p p y r ' � k �r Disposal Field: Distance from nearest ell--164___f._.Distance from foundatizr� - Distance to nearest lot ® Number of lines---------_________ +y�_ _Length of each line��.?_� ,- -d .Wicith of trench_____"_r Type of filter material- , Depth of filter materia____ ___ ___ ____Total length_______- -----_-'_______ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- ElNumber of pits----------------------Lining material----------------------.Size: Diameter-------------.----------Depth------------------------_-------fi Cesspool; Distance from nearest well----------------- from foundation---------- ---.-----Lining - - material----------_--------------_______- ❑ Size: Diameter-------------------------- Depth ---- - ` __----- ----- Capacity.. l ------------ , _. Priv Distance from nearest well------- Distance from+nearest buildin .. ❑ Distance to nearest-lot-line_---------- _ -_�-- - - Remodeling and/or repairing {describe):__!//!.__--�-- -�-- -----------------------�+?:f ��__ -- - ---- `----------------------- ------ -- E^r-'r y f ----------- im:_-�- ° __�. r ------s. ' --------------I^-`-"--f'= /1 /r +# ----- / ----- = ----•----- ---- ------•--------------------- ------------------------------------------`-----------------------------— ---------------------------------------------------------- ----------------------------------------------------------•----------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- ----- ------- ---------------------------------------- .- ---_---------r--- - - (Ow.ner..and/or>Eontractor) t - g . _ I - Y ------------------------------------ ----- ----� ------------- --------------------------------- - --{Title)_ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can beplacedon reverse side) _ ,'.. ; FOR DERARTMENT USE O LY' f� APPLICATION ACCEPTED BY----- a - . REVIEWEDBY--------------------------------------------- ---------------------------------------•--------------------- --------------- DATE-------- ------------------------------- BUILDING --•---•--•-------------------BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ ----------- DATE----------------------------------------------------------- Alterations and/or recommendations-----------------------------------------------------------------------------------------------------------------------------_---- ------------------ ------------------------------- --------------------------------•------------------------------ -------------------------------------------------- .. -- - ----- ------------------------------------ - - ----- --- FINAL INSPECTION BY: -Dat d 4 SAN JOAQUIN LOCAL HEALTH DISTRICT � 130 South American Street �` 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California A ES-9-2M Revised 1.57 FRP 0.